An unusual case of recurrent Guillain-Barre syndrome with normal cerebrospinal fluid protein levels: a case report

Abstract

Background

Guillain-Barre syndrome is an acquired polyradiculo-neuropathy, often preceded by an antecedent event. It is a monophasic disease but a recurrence rate of 1-6 % is documented in a subset group of patients. Patients with Guillain-Barre syndrome show cerebrospinal fluid albuminocytologic dissociation. Normal cerebrospinal fluid protein levels during both initial and recurrent episodes of Guillain-Barre syndrome is a rare occurrence and has not been described earlier in the literature.

Case presentation

Twenty-five-year-old Sri Lankan female with past history of complete recovery following an acute inflammatory demyelinating polyneuropathy (AIDP) variant of Guillain-Barre syndrome 12 years back presented with acute, ascending symmetrical flaccid quadriparasis extending to bulbar muscles, bilateral VII cranial nerves and respiratory compromise needing mechanical ventilation. Nerve conduction study revealed AIDP variant of Guillain-Barre syndrome. Cerebrospinal fluid analysis done after 2 weeks were normal during both episodes without albuminocytologic dissociation. She was treated with intravenous immunoglobulin resulting in a remarkable recovery. Both episodes had a complete clinical recovery in three and four months' time respectively, rather a faster recovery than usually expected.

Conclusion

Recurrence of Guillain-Barre syndrome can occur in a subset of patients with Guillain-Barre syndrome even after many years of asymptomatic period. Normal cerebrospinal fluid profile does not exclude Guillain-Barre syndrome and may occur in subsequent recurrences of Guillain-Barre syndrome arising the need for further studies to identify the pathophysiology and the possibility of a different subtype of Guillain-Barre syndrome.